New member benefit: Brain Injury Services Case Management

Beginning January 1, 2024, Brain Injury Services Case Management (BIS CM) is an included benefit for members aged 18 and older who have sustained traumatic brain injury. Brain Injury Case Management provides service coordination and person-centered planning with members who have sustained a traumatic brain injury.

Before a member may receive services, a BIS case manager must complete the Mayo-Portland Adaptive Index-4 screening to determine whether the member meets the required severity threshold for BIS CM service. This assessment is billed using procedure code S0280. Prior authorization for BIS CM assessments will only be required for assessments that exceed the service limit of two assessments within a period of 365 consecutive days. A traumatic brain injury (TBI) triggering event must be documented to approve assessments that exceed the service limit.

A brain injury triggering event is defined as a TBI event that suggests a change in the member’s condition or status.

If the assessment determines that the member meets the required threshold for services, providers must complete and submit the Brain Injury Services Case Management Service Authorization Review Form and physician documentation of a traumatic brain injury to initiate authorization review.

The procedure code for maintenance of the BIS CM plan is S0281 and has a limit of one unit per month for six months. A new assessment and updated plan of care must be completed every six months.

Existing BIS CM providers within our network who are interested in providing services should contact their assigned network manager for more information.

If you have any questions about this communication, call Anthem HealthKeepers Plus Provider Services at 800-901-0020.